The World Trade Center Health Registry includes 9/11 survivors who have been surveyed about their health conditions over time. The prevalence of posttraumatic stress disorder (PTSD) remains high among the cohort and is a risk factor for cognitive impairment or dementia. We thus sought to examine the degree to which confusion or memory loss (CML)—potential symptoms of cognitive decline—are occurring among enrollees aged 35–64 years. Cognitive reserve theory suggests that higher levels of education and engaging in cognitively challenging activities can create stronger neural connections, offering protection against cognitive decline. We hypothesized that enrollees with less cognitive reserve would be more likely to report CML. In this study, we: (1) estimated the incidence of CML in our study sample; (2) identified indicators of cognitive reserve (e.g., indicators of educational attainment, social support); and (3) determined whether CML is associated with cognitive reserve level, stratified by PSTD status. First, we described demographics of the study sample (n = 14,574) and probable PTSD status, also stratifying by CML. Next, we conducted a latent class analysis on two groups: those with probable PTSD and those without probable PTSD, creating classes with varying cognitive reserve levels. Finally, using adjusted log binomial models, we predicted risk of CML based on cognitive reserve level. The probable PTSD group (n = 1213) and not probable PTSD group (n = 13,252) each had four latent classes: low, medium-low, medium-high, and high cognitive reserve. In the probable PTSD model, compared to the high cognitive reserve class, those with medium-low cognitive reserve were 35% more likely to report CML (relative risk (RR) = 1.4, 95% confidence interval (CI): 1.1, 1.7). Among the not probable PTSD group, those with low and medium levels of cognitive reserve were significantly more likely to report CML (RR = 1.8 and 1.4, respectively). Overall, those with less cognitive reserve were more likely to report CML regardless of PTSD status.

Numerous studies report elevated levels of chronic mental health conditions in those exposed to the World Trade Center attacks of 11 September 2001 (9/11), but few studies have examined the incidence of confusion or memory loss (CML) or its association with mental health in 9/11 attack survivors. We investigated the incidence of CML and its association with the number of post-9/11 mental health conditions (PTSD, depression, and anxiety) in 10,766 World Trade Center Health Registry (Registry) enrollees aged 35–64 at the time of the wave 4 survey (2015–2016) that completed all four-wave surveys and met the study inclusion criteria. We employed log-binomial regression to evaluate the associations between CML and the number of mental health conditions. A total of 20.2% of enrollees in the sample reported CML, and there was a dose-response relationship between CML and the number of mental health conditions (one condition: RR = 1.85, 95% CI (1.65, 2.09); two conditions: RR = 2.13, 95% CI (1.85, 2.45); three conditions: RR = 2.51, 95% CI (2.17, 2.91)). Survivors may be experiencing confusion or memory loss partly due to the mental health consequences of the 9/11 attacks. Clinicians treating patients with mental health conditions should be aware of potential cognitive impairment.

The health consequences of the 9/11 World Trade Center (WTC) terrorist attacks are well documented, but few studies have assessed the disaster’s impact on employment among individuals exposed to the disaster. We examined the association between 9/11-related health conditions and early retirement among residents and workers who resided and/or worked near the WTC site on 9/11, and the association between such conditions and post-retirement income loss. The study included 6377 residents and/or area workers who completed the WTC Health Registry longitudinal health surveys in 2003–2004 and 2006–2007, and the 2017–2018 Health and Employment Survey. Logistic regression models were used to examine the associations. We found that 9/11-related health conditions were significantly associated with the likelihood of early retirement. Residents and/or area workers with more physical health conditions, especially when comorbid with posttraumatic stress disorder (PTSD), were more likely to retire before age 60 than those with no conditions. For retirees, having PTSD or PTSD comorbid with any number of physical conditions increased the odds of reporting substantial post-retirement income loss. Disaster-related outcomes can negatively impact aging individuals in the form of early retirement and income loss. Long-term effects of major disasters must continue to be studied.

This study described patterns of response versus nonresponse, earlier versus later response, and paper versus web response to the 2017–2018 Health & Employment Survey (HES). We predicted odds of responding to the survey based on demographic factors and examined impact of multiple email reminders on response volume. The overall completion rate was 65%. The likelihood of responding to HES was more than doubled when the web survey was an option. Most web surveys were received during the first two months of data collection compared with less than one-third of paper surveys. Multiple email reminders resulted in increased responses. To offer mode options to all, more efforts should be made on collecting valid email addresses.

Context: Survey panels can allow for more efficient data collection than traditional surveillance surveys both in terms of cost and operations. Seeking an alternative way to collect timely, high-quality data, the New York City (NYC) Health Department created a probability-based survey panel. Program: The NYC Health Panel was launched in April 2020. Over its first 2 years, the Panel recruited adults (ages 18+) in NYC from address-based lists and probabilistic surveys. Implementation: Once enrolled, panelists were invited to participate in up to 10 surveys per year. Surveys could be completed online (self-administered) or via paper or phone (computer assisted telephone interview) and were offered in 5 languages. Panelists were reconsented at the start of each survey and offered an incentive at completion. Panelists were compared to the 2017-2021 5-year American Community Survey data of NYC adults to assess representativeness. Weighting was used to adjust for these differences. Evaluation: The NYC Health Department was able to successfully launch the Panel and collect survey data. In its first 2 years, the Panel enrolled approximately 13 000 adult NYC residents and conducted 18 surveys. Most surveys were completed online and in English. The Panel’s size and probabilistic design allow for the creation of individual survey samples that are representative of adult NYC residents. Discussion: The NYC Health Panel is an invaluable resource in response to the COVID-19 pandemic, in assessing racial inequities, and in measuring the secondary pandemics of food insecurity, delayed primary care, and adverse mental health. It serves as a unique example of how health departments that have the necessary in-house staff resources can collect timely data.